As a medical oncologist in Wake County for the past 35 years, I have seen major changes in the types and numbers of different therapies available. These new treatments have played a major part in improving survival of patients with all different types of cancer.
Just in the area of my specialty, prostate cancer, six new treatments that help patients live longer have been approved by the FDA since 2004, five of those in the last four years.
Traditionally, the most expensive cancer drugs have been administered in the hospital clinic or oncologists offices because they had to be administered by injection or intravenous infusion. These expensive injectable drugs have been covered, with the exception of modest copays for the patient, by health care insurance companies, Medicare and Medicaid.
However, many of our newest and most effective cancer drugs are taken by mouth at home, usually on a daily basis. Two of those new prostate cancer drugs are orally administered, and patients whose disease responds well to them can potentially be on these drugs for years. Other common cancers such as lung and breast cancer also have seen the development of new oral drugs, which can be very effective for patients with certain disease characteristics determined by genomic and other types of analyses of the patients individual cancer. Chronic myelogenous leukemia has gone from a disease that was uniformly fatal to one in which almost no one dies, all due to the amazingly effective new oral targeted therapies.
The examples in other cancers go on and on, as new drugs are approved every month.
The availability of all these new oral drugs is great news, but there is a problem. Insurance companies and Medicare cover these drugs only with the traditional outpatient prescription benefit system.
The new oral cancer drugs, like all the injectables, are extremely costly. Most of the drugs approved since 2010 can retail for $5,000 to $10,000 per month or more. The traditional prescription benefit can leave the patient with a huge monthly copay of several thousand dollars.
The drug companies have programs, and certain foundations can help patients with copay assistance, but there are limits to the availability of these funds.
I have personally had several patients who could not obtain potentially very effective oral drugs for their prostate cancers because of inability to pay. Ironically, these same patients could easily afford chemotherapy with their current insurance coverage with no copay assistance.
There is a possible solution to the differential in access to oral and injectable cancer drugs. Thirty-three states and the District of Columbia have tackled this issue with oral oncology parity laws. North Carolina is considering similar action with House Bill 609. These laws would require health plans regulated by the state insurance commission to place limits on patient out-of-pocket costs for oral cancer medications that are in line with patient out-of-pocket expenses associated with IV chemotherapy.
Insurers have no incentive for such laws to pass. These companies argue that such laws would increase their costs and that rates would therefore have to be raised for all. That may be true, but the time has come to reform the oral prescription benefit to allow all patients equal access to oral as well as injectable cancer therapy.
William R. Berry, M.D., works at Cancer Centers of North Carolina in Raleigh.